Portal vein aneurysm: when to operate?

Flis, Vojko; Matela, Jože; Gadžijev, Eldar

doi:10.1016/s1533-3167(03)00025-6

Cited by 8 publications

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19,20,41,66 Patients operated with aneurysm of the extrahepatic main portal vein or superior mesentericesplenic vein confluence underwent various procedures, most frequently aneurysmorrhaphy. 21,31,43,55,58,69,77,80 A single patient with intrahepatic portal aneurysm was operated: he had documented portal hypertension and underwent splenectomy 57 (Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

Visceral Venous Aneurysms: Clinical Presentation, Natural History and Their Management: A Systematic Review

Sfyroeras

Antoniou

Drakou

et al. 2009

European Journal of Vascular and Endovascular Surgery

131

View full text Add to dashboard Cite

The most frequent location of visceral venous aneurysms is the portal venous system. They are often associated with cirrhosis and portal hypertension. They may be asymptomatic or present with abdominal pain and other symptoms. Watchful waiting is an appropriate treatment, except when complications occur. Most common complications are aneurysm thrombosis and rupture. Other visceral venous aneurysms are extremely rare.

show abstract

Section: Discussionmentioning

confidence: 99%

Visceral Venous Aneurysms: Clinical Presentation, Natural History and Their Management: A Systematic Review

Sfyroeras

Antoniou

Drakou

et al. 2009

European Journal of Vascular and Endovascular Surgery

131

View full text Add to dashboard Cite

show abstract

“…Similarly, there have been eight reported cases of successful aneurysmorrhaphy in the literature and reported morbidity is low. 9,14,15,[18][19][20][21] For fusiform portal vein aneurysms, if an aneurysmectomy is performed, a conduit to replace the resected portal vein segment is required and an allograft from a cadaveric donor, as in our case, or a synthetic graft can be utilized. The presence of liver disease also influences the surgical procedure chosen for portal vein aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Extrahepatic Portal Vein Aneurysm—Report of Six Patients and Review of the Literature

Cho

Marsh

Fontes

et al. 2008

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Extrahepatic portal vein aneurysm is a rare condition. We report six patients with extrahepatic portal vein aneurysm, four of whom were surgically treated. In addition, a review of the literature was performed to examine natural history, management, and outcomes regarding portal vein aneurysm. Patients seen at our institution with extrahepatic portal vein aneurysm greater than 1.9 cm in diameter were reviewed (1998 to 2006). There were five females and one male; median age was 66.5 (30-77). Computed tomography (CT) scan was utilized for diagnosis in all cases. The median diameter of the aneurysm was 4.7 cm (2.7-6.0). Indications for surgery included gallstone pancreatitis, mass effect on the adjacent duodenum, a peripancreatic mass, and liver cirrhosis. Three patients underwent aneurysm resection, and one patient had an orthotropic liver transplant. Two patients were managed with observation. The median follow-up from first presentation and surgery was 50 months (9-181) and 5 months (2-73), respectively. At last follow-up, five patients were alive with radiologically proven portal vein patency. One patient died 2 months after liver transplantation. There was no case of aneurysmal rupture. One patient had intramural thrombus at presentation that resolved with conservative treatment. This report suggests that symptomatic aneurysms can be safely resected with excellent patency.

show abstract

“…Brock et al postulated that patients with thrombosis extending to splenic vein and superior mesenteric vein should undergo thrombectomy and restoration of portal vein anatomy; but complication rates of surgical management have not been reported. 7 A conservative approach may have a lower complication rate as in Case 4 in our cohort.…”

Section: Discussionmentioning

confidence: 63%

“… 6 In the absence of portal hypertension, aneurysmorrhaphy is preferred as it restores portal vein laminar flow while preserving normal hepatic flow, and decreases stasis and resultant thrombosis. 7 …”

Section: Discussionmentioning

confidence: 99%

Portal vein aneurysm, a pathological entity or an innocent bystander? A review of six cases

et al. 2022

View full text Add to dashboard Cite

Portal venous aneurysms (PVA) are a rare venous aneurysms. The mean diameter of a healthy portal vein varies considerably, with maximum diameter of 15 mm in healthy subjects and 19 mm in cirrhotic patients. The presentation varies; they could come with abdominal pain or more often as an incidental, asymptomatic finding. Although risk factors like portal hypertension and liver cirrhosis have been highlighted, the aetiology remains to be clarified. PVA may be associated with various complications: thrombosis, aneurysmal rupture, inferior vena cava obstruction or duodenal compression. A conservative treatment showed satisfying clinical and radiological response, however, surgical and endovascular options can be considered. The aetiology and the mechanism of formation of PVA remain ill defined. We aimed to use the small cohort of cases to define the distribution and radiological features of PVA and not for determining its prevalence or details of management. We retrospectively reviewed 6 cases from our institution with variable presentations, complications and outcomes. Contrary to the published literature where most of the PVA’s are described in extrahepatic portal vein and portal-splenic vein confluence, majority of our cases (66%) were found to be in intrahepatic locations. In our study, two (33%) of the patients had portal vein thrombosis and were symptomatic. PVA was associated with cirrhosis and portal hypertension in only one patient (16%). These findings support the hypothesis that chronic liver disease and portal hypertension may be contributory but are not essential factor in the development of portal venous system aneurysm. Our review revealed that portal venous system aneurysms were mostly incidental, single, not gender or age specific and were frequently (66%) intrahepatic. Main portal vein was involved in 3 cases and splenic vein in only one case. Most of the portal venous system aneurysms were fusiform in configuration. Although PVAs are rare, more cases are detected through imaging. Hepatobiliary surgeons, gastroenterologists and radiologists should be aware of this entity, as it can have a wide variety of clinical spectrum. Our review and the limited evidence in published literature suggest that an individualized multidisciplinary team approach should be adopted to decide the best management and outcomes for each patient. The authors of this manuscript have no conflict of interests to disclose

show abstract

Portal vein aneurysm: when to operate?

Cited by 8 publications

References 14 publications

Visceral Venous Aneurysms: Clinical Presentation, Natural History and Their Management: A Systematic Review

Visceral Venous Aneurysms: Clinical Presentation, Natural History and Their Management: A Systematic Review

Extrahepatic Portal Vein Aneurysm—Report of Six Patients and Review of the Literature

Portal vein aneurysm, a pathological entity or an innocent bystander? A review of six cases

Contact Info

Product

Resources

About